Skip to main content
main-content

01.11.2010 | 2010 SSAT Poster Presentation | Ausgabe 11/2010

Journal of Gastrointestinal Surgery 11/2010

Pancreatoduodenectomy for Ductal Adenocarcinoma in the Very Elderly; Is It Safe and Justified?

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 11/2010
Autoren:
Saboor Khan, Guido Sclabas, Kaye Reid Lombardo, Michael G. Sarr, David Nagorney, Michael L. Kendrick, John H. Donohue, Florencia G. Que, Michael B. Farnell

Abstract

Background

The outcomes of complex major surgery in the elderly are being scrutinized because of the demands on surgical services by an aging population and the concern whether such endeavors are justified. Pancreatoduodenectomy (PD) for pancreatic adenocarcinoma presents special challenges because of the high morbidity of the procedure, dismal prognosis of the disease, and the increasing incidence of pancreatic cancer with age.

Methods

All patients who underwent PD for pancreatic adenocarcinoma from 1981 to 2007 were analyzed for perioperative outcomes, tumor-related parameters, use of adjuvant therapy, and long-term survival. Specifically those aged ≥80 years were compared with a control group aged ≤80 years. Continuous variables are displayed as median and interquartile range (IQR); log-rank test and Cox’s proportional hazards were used to determine survival and effect of age as an independent marker against other covariates.

Results

Fifty-three patients aged ≥80 years underwent PD. Twenty-six (51%) developed complications, including delayed gastric emptying (nine, 17%), pancreatic leak (six, 11%), and postoperative bleeding (five, 9%). There was one in-hospital death (2%). The hospital stay was 13.5 days (IQR 9–19). Forty-one (79%) patients were discharged home; of the 11 (21%) patients who went to an outside health care facility (pancreatic leak/drains and feeding issues—five, delayed gastric emptying/nutritional—four, no home support—one), one died in a nursing home at 5 months while the other ten patients returned to their previous abode (median 4 weeks). The median disease-free and overall survivals were 11.8 (IQR 7.8–18.4) and 13.5 months (IQR 12–21.3). Compared to the non-octogenarians (n = 567), the older population had more poor risk patients with respect to ASA status (P < 0.0004), stayed longer as in-patients (P < 0.04), were more likely to develop complications (P < 0.001), and were less likely to receive adjuvant therapy (P < 0.0001). There was no difference in long-term disease-free or overall survival (log-rank P < 0.30 and P < 0.14), and age did not appear to be an independent marker of prognosis when analyzed (Cox’s proportional hazards P < 0.26; chi-square, 1.25).

Conclusions

In experienced institutions, PD for ductal adenocarcinoma is a viable option in the ambulatory octogenarian population who are deemed operative candidates for a PD. The trade off is a greater complication rate and the prospect of discharge (one in five) to a chronic care facility. The majority, however, can be discharged home with a reasonable functional status, and those discharged to temporary health care rehabilitation facilities are likely to make a recovery over a few weeks.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

★ PREMIUM-INHALT
e.Med Interdisziplinär

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de. Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

Weitere Produktempfehlungen anzeigen
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 11/2010

Journal of Gastrointestinal Surgery 11/2010 Zur Ausgabe
  1. Das kostenlose Testabonnement läuft nach 14 Tagen automatisch und formlos aus. Dieses Abonnement kann nur einmal getestet werden.

Neu im Fachgebiet Chirurgie

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Chirurgie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise